A Comparative in vitro Assessment of Suture Strength after Exposure to Pancreatic Enzyme Solution
Background Post-operative pancreatic fistula (POPF) is a major cause of short-term morbidity following pancreatic resection. There is wide variation in the selection of suture type for pancreaticoenteric anastomoses resulting from a paucity of data pertaining to changes in suture strength after exposure to pancreatic enzymes. This study aimed to investigate the effect in vitro of a simulated pancreatic enzyme-rich environment on the tensile strengths of various suture materials. Methods Ten replicates of five different suture materials (polydioxanone; polyester; polyglyconate; polypropylene and barbed polybutester) were tested for tensile strength after incubation for ten days in either a pancreatic enzyme solution (PES) or in a control normal saline solution. Results Four of five suture materials (polydioxanone; polyester; polyglyconate; polypropylene and barbed polybutester) did not demonstrate any significant decrease in tensile strength after exposure to PES compared with normal saline. Polypropylene demonstrated a significant decrease in tensile strength after incubation in PES compared with normal saline (mean (SD), 33.4 (2.59) vs 36.51 (2.78) N; p=0.019). Conclusion The tensile strengths of polydioxanone, polyester, polyglyconate and barbed polybutester are not significantly affected by exposure to pancreatic enzymes. The tensile strength of polypropylene suture is significantly decreased by exposure to pancreatic enzymes.
Merei Ibrahim, Nahm Christopher B, Ofri Adam, Samra Jaswinder, Clarke Elizabeth, Anubhav Mittal